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Strong Outcomes Require Strong Relationships

So much of the human experience is built around relationships. Family units, loved ones, friends, colleagues, local communities, and others we interact with on a regular basis (like the barista down the street) are the fiber of our outward experience in the world. Without relationships, we begin to function differently and suffer. The current pandemic has highlighted the negative impact of social isolation as millions of Americans feel it more acutely than ever beforeSimply put, relationships are fundamental to our health and survival.

Trust goes hand-in-hand with relationships. If you think about people you trust the most, odds are you have a long-established relationship with them. They’ve demonstrated over time that they can be trusted and are reliable. Once established, trust helps us bypass a lot of analysis and consideration when given advice or taught something. We more quickly internalize and implement recommendations and processes when they come from someone we trust, which is immensely valuable. Don’t believe me? Ask your mother.

How do relationships impact quality healthcare?

Just like any other community, it’s crucial that healthcare organizations build and maintain positive relationships with their consumers. Consumers rely on trusted relationships to help them make decisions on their care. A 2017 Oliver Wyman study showed that US healthcare consumers are more likely to consult close friends and family on whether to seek healthcare treatment than they are to ask their providers. Health insurers ranked dead last. When consumers feel like they have a positive, trusting relationship with their health plan, provider(s), or other organization, the barriers to sharing information, activating them in health behaviors, seeking appropriate care, and ultimately taking any action all shrink. The strength and sentiment of the relationship between each healthcare organization and their individual consumers is a key indicator of how effectively the organization can impact each consumer’s life and quality of care. Additionally, happy consumers make a direct impact on CAHPS scores and Star ratings.

It may be no surprise that relationships take time and investment to build. You probably can’t walk up to a random stranger on the street and ask for a ride to the airport. But you probably have friends or family that would be willing to take you. In part, it’s because they know you will be there when they need you, too. You have been there before; you will be there again. So how do you create this same feeling and dependability between your organization and your consumers?

Start now. Build meaningful connections with your consumers. Build trust with your consumers. Begin that positive relationship. Ask them questions in your outreach, and listen to their answers, either through staff or with technology like Natural Language Understanding (NLU). If you feel like you already have a strong relationship with your consumers, then make sure you are nurturing that relationship. The more they trust and rely on you, the more they will heed your advice or take the action you recommend. You cannot wait until the moment you need them to do something to start engaging them because consumers don’t see their relationship with you as a series of campaigns. It needs to be an ongoing, two-way relationship to create the best health and business outcomes.

Some great examples of this challenge can be found in COVID-19 outreach. Many organizations increased the amount and type of consumer outreach to inform them about rapid changes to policies, benefits, care instructions, and a lot of other information as things rapidly changed. In some instances, consumers were confused. This type of outreach and interaction was new. It felt like it came out of nowhere. If they had a stronger relationship with the organization communicating with them, and if communication like this was more typical, they would likely be more receptive and trusting.

Takeaway: start building valuable relationships now so they are there when you need them.

mPulse prides itself on helping healthcare organizations communicate with their members with the content they need through the channels they prefer. If you would like to learn more about how we can help you connect more deeply with your consumers, please contact us.

Only The Lonely…Social Isolation in the Modern World

A healthy mind in a healthy body is a phrase that’s been around for two millennia (an ancient Roman is credited with it).  Originally meant to convey faculties we should aspire to, it later came to capture the interdependence of mental and physical wellness.  The ancient Romans had an imperfect understanding of this fragile equilibrium compared to today, but many of the same factors that conspired against the ancients and a healthy mind-body equilibrium still threaten us.  One of the most insidious is loneliness.

The COVID-19 pandemic has also coined a phase—social distancing.  This lesser of two evils has limited social interaction and left us, temporarily, in a lonelier world. It has also weakened the social support structures we previously took for granted, and which help sustain a ‘healthy mind in a healthy body.’ The Disaster Distress Helpline at the Substance Abuse and Mental Health Services Administration saw an almost nine-fold increase in calls in March 2020 compared to a year ago. Troubling as this trend is, it may also be something of a red herring.

Isolation—perceived or actual—is an omnipresent risk and chronic, long-term reality. According to a 2018 national survey by Cigna, levels of loneliness have reached an all-time high,  with half the 20,000 surveyed reporting “they sometimes feel alone.” The Health Resource and Service Administration reports that a quarter of the U.S. population and almost one-third of older adults lives alone, and this number has been rising over the last decade.  A recent meta-analysis published in the Monitor on Psychology of the American Psychological Association, determined that a lack of social connection heightens health risks “as much as smoking 15 cigarettes a day or having alcohol use disorder.”

Typical consequences of chronic loneliness include cardiovascular disease, chronic depression and attendant risk of suicide; also cognitive decline, Alzheimer’s disease, and an overall, elevated risk of mortality.   The meta-research further suggests, “chronic loneliness is most likely to set in when individuals either don’t have the emotional, mental or financial resources to get out and satisfy their social needs or they lack a social circle that can provide these.”

The current pandemic has doubtless highlighted the issue of loneliness, and this silver lining  may yet prompt structural changes in healthcare and perceptions of what it is to be isolated.  For now, the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020, which was signed into law on March 6, has expanded digital and tele- mental health services in order to prevent further decompensation (inability to summon up psychological coping mechanisms) and avoid potential consequences like suicide attempts, emergency department visits and need for psychiatric hospitalizations, in a resource-constrained environment.

Beyond the pandemic, it is likely that longer-term support frameworks will be needed. Psychiatrist Damir Hueromevic, who co-authored the (prescient) 2019 book Psychiatry of Pandemics: A Mental Health Response To Infection Outbreak, is one of many commentators with a cautionary note. The book warns the secondary effects of the pandemic such as recession, social unrest and unemployment, could trigger widespread and ongoing mental health challenges.

The difficult truth is that even a nominal end to the “social distancing” will not necessarily end the isolation issues it engenders.  In fact, Science News reports that even relatively shorter-term isolation can lead to longer-term psychological problems, consistent with post-traumatic stress. Some studies even hypothesize a chemical “switch” that is flipped during longer-term isolation.  A team of researchers at Caltech demonstrated over an extended series of studies that prolonged social isolation in mice could lead to physical changes in the structure of the brain’s neuroreceptors.  This caused behavioral changes, including increased aggressiveness and persistent fear.  Such responses remained “frozen in place” long after the isolation ended. Humans possess a similar physiological brain chemistry to the areas impacted in the mice.  Other human-based studies suggest that isolation can be recursive. Being isolated and lonely can further weaken the motivation and ability to engage with others, leading to still greater isolation… and so on.

The physical and mental effects of loneliness and social detachment may be unsurprising given what we know about the mind and psychosomatic illness. What might surprise, however, is a significant remedy.  In the context of mitigation, “giving” can actually be better than “receiving.”   Research on those suffering from loneliness affirms that by helping others, not only can the “giver” gain the benefit of a social network, but gain a sense of purpose. This altruistic behavior, according to findings presented in Scientific American  creates a valuable social bond with others and stimulates the mind to build neural connections which make the brain more resilient to cognitive decline and dementia-related diseases, like Alzheimer’s.

While on the subject of giving versus receiving—if you’re reading this article and work for a provider, managed care plan or other organization vested in caregiving, here’s some news that might resonate: Helping others and doing so effectively not only helps your member population, but can also improve employee productivity.   A wide body of research – collectively called the “Happy Worker Thesis” – demonstrates that happy people are more productive.  A recent study of call-center employee productivity described a strong causal effect of happiness on sales and other key interactions. mPulse Mobile understands this premise well.

The mPulse Mobile Engagement Console – the browser-based UI that lets staff manage text interaction with members – is designed to give staff more capacity to focus on higher-order, more valuable and satisfying interactions instead of spending time outbound calling or answering simple questions. Research also supports the flip side of the happy=productive equation. Productive people, like your employees, tend to be happier.  Why? Because being productive can translate to a greater sense of purpose, which improves self-esteem.  It can also enhance mental satisfaction and the release of endorphins.

Finally – as you address your own challenges including those of the “new normal” – know you aren’t alone. mPulse is a leader in engaging consumers about healthcare challenges and how they change relative to public health issues – the pandemic being one example. We build dedicated programs that respond to, evolve with, and anticipate this change.   Our platform helps activate consumers to drive healthy behavior change, by efficiently and effectively engaging them in meaningful conversations, ultimately strengthening their relationship with the healthcare organization that supports them.

Building on this expertise, mPulse Mobile has put together a COVID-19 Strategic Communications Tool Kit. It comprises a coordinated suite of programs and resources to help you purposefully connect your population to services, information and updates during this crisis and the recovery phases to follow. These include resources to mitigate adverse effects of social isolation among your population. Our COVID-19 Strategic Communications resources address varied the messaging and communications challenges of the pandemic and are based on direct experience and collaboration. To date, we’ve supported tens of millions of COVID-19 communications to patients and members via SMS, email, IVR and mobile web.

COVID-19 Member Engagement: Our Top 5 Best Practices

Health plans are confronting the COVID-19 outbreak on a wide range of fronts. Member engagement and outreach has become crucial as people want to hear accurate information and access helpful resources from the organizations that manage their care. The rapidly changing nature of the crisis and the massive amount of questions and concerns that members have about it makes this a uniquely difficult communication challenge. As a partner to some of the best and largest plans in the country, mPulse Mobile has been helping our clients face that challenge, sending over 10 million messages about COVID-19 to Americans in the first week after the WHO declared it a pandemic. Three weeks in that figure has grown to over 20 million. As plans and providers grapple with how best to keep members informed while maintaining focus on delivering care and support to the members who most need it, we identified 5 key best practices to help our clients navigate COVID-19 outreach:

Focus on Efficiency

Getting accurate and timely information to your population is a top priority. As the crisis progresses, it becomes difficult to focus on building and maintaining outreach efforts, and “build-your-own” vendor tools can take deceptively long to deploy. Now is not the time to task an IT team with implementing and managing self-service tools or develop content for new channels for the first time. Work with a healthcare-focused partner with existing and ready-to-launch content to help you keep your members aware of resources you have available (e.g. telehealth, mail-order pharmacy, etc) and updates to shelter-in-place and social distancing guidance.

To help organizations launch and optimize programs quickly and confidently, we developed our COVID-19 Strategic Communications toolkit, which has details on our ready-to-launch programs and essential platform capabilities. Click here to learn more.

…But also, Be Strategic

As Covid-19 continues to evolve, it’s critical to plan outreach strategically. The urgency of the situation makes it tempting to send mass communication through emails, mailing, or broadcast phone or text outreach whenever there is new information. We have seen organizations find the most success when they work with us to plan content, channel mix, frequency, readability, and language. You want to be a consistent, trusted, and an easily accessible resource for members – that means being careful to not over-message or use channels with limited reach and engagement, or use content that is not optimized for your audience or outreach method. Strategically thinking about the way you deliver those messages will not only drive critical resources to members efficiently, it will also build a stronger long-term line of communication as conditions shift.

Help Your Staff Through Automation

Call centers are heavily impacted during this time. We have heard from clients that members are calling into nurse lines and member services centers with COVID-19-related questions at an extremely high rate. Help throttle inbound calls by leveraging the automated outreach that gets general information and self-service resources into members’ hands before they call. Proactively sending members links to telehealth options, online resources, and symptom checkers, (the CDC has one if you don’t yet will help members with COVID-related questions without calling in for additional questions.

Be Ready for Members’ Responses

Because of its unmatched reach and read rates, using SMS is an obvious best practice in crisis situations. But the conversational nature of the text channel combined with the uncertainty and dynamism of this crisis means that you need to be prepared for members to reply back with questions or concerns. In the initial weeks of the pandemic, we have seen even 1-way text campaigns that do not solicit any response receiving high levels of replies from members. Generic autoresponders that ask members to call a number for help can cause member abrasion and more inbound calls at a time when you want to avoid them (see #3). At minimum, you should ensure that member responses to COVID-19 messaging receive relevant auto-responses.

mPulse has gone a step further and developed a Natural Language Understanding domain around COVID-19. This domain reads and automatically categorizes non-standard responses so that members get questions answered and concerns addressed. It dynamically updates as members reply to outreach, so programs will get better at understanding member replies over time.

Support your entire population

While broadcast messages out to your members are fast and easy, it’s crucial to ensure your strategy accounts for differences across your members to ensure ongoing outreach is relevant and effective going forward. Utilizing zip code segmentation allows for content to be tailored to members in specific areas, allowing for updates on specific facilities, services, or public health guidance. We have also seen plans using fotonovelas to reach multicultural segments of the population. They use comic-style graphics that help break down language barriers and can be utilized during COVID-19 to showcase best practices, resources, and updated information.

The COVID-19 crisis has placed tremendous pressure on the healthcare system, including how it communicates to the populations it cares for. With these practices, plans can get the right information out to the right people efficiently and effectively. For more help, email Review our COVID-19 Strategic Communications toolkit, where you can find details on multiple COVID-19 programs. Click here to access the toolkit.

mPulse Mobile Holds Its Third Annual Activate Conference

mPulse Mobile wrapped up its third annual Activate conference last month. Activate2019 was another resounding success at the Marina Del Rey Hotel on October 9th and 10th with over 100 leaders from across the healthcare engagement landscape.

mPulse’s CEO and Co-Founder Chris Nicholson kicked things off with his outlook on how the conversation about healthcare consumer engagement has changed dramatically in just the last few years. The role of Conversational AI in adding capacity and improving access to care took center stage early on, with an insightful keynote address by Kaveh Safavi MD, JD – Senior Managing Director and Head of Global Health Practice at Accenture – that focused on how AI can change the future of healthcare. His talk focused on the practical and actionable ways that automation and scale can (and must) be applied to healthcare to confront some of the major challenges of the present and future.

Attendees then heard from the first of three panels of mPulse Mobile clients driving improved outcomes through innovative mobile solutions. Susan Arcidiacono, Chief Marketing Officer at Inland Empire Health Plan discussed how text message programs extended and enhanced her team’s efforts to close gaps in care, improve member experience, and promote preventative service utilization for a large Medicaid population. Sagar Makanji, the VP of Clinical Programs at Magellan Rx Management, then outlined how the PBM has transformed member engagement to help client plans improve Medicare Part D Star Ratings.

The next panel featured three clinical leaders from Kaiser Permanente – Winston Lai, Innovation Lead, Amy Chateau, Manager of Ambulatory Care, and Kristi Tague, Support Services Supervisor. They discussed how tailored and Conversational AI-enabled messages drove improved screening completion rates for key populations. The team shared specific workflows and best practices they used to improve colorectal cancer screening and pulmonary function test completions in San Diego.

After a lunch on the Marina and a roadmap update from our CTO Ram Prayaga, attendees took part in interactive workshops to develop new applications for Conversational AI in healthcare and engaging with the data that these solutions generate. The final customer panel of the day featured Donna Stanislawski, Director, Quality and Population Outcome at IlliniCare Health, Jacqueline Thong, Senior Director of Product Performance at Docent Health, Erwin Jeong, Pharmacy Clinical Operations Manager at Kaiser Permanente, and Rachel Fournier, Director, Product Management OnTrak Digital at Catasys. The group heard from Donna how IlliniCare manages a wide range of key engagement initiatives with a difficult-to-reach population. Jacqueline explained how Docent Health has embraced the text channel and mPulse’s Engagement Console to provide impactful support to patients during the care journey. Erwin detailed how Kaiser Permanente leverages mPulse’s Social Determinants of Health Index to predict Medicare members’ Medication Adherence rates. And Rachel shared learnings and best practices for deploying innovative solutions to engage large populations about behavioral health.

After Chris Nicholson shared his key takeaways and and announced the winners of our Activate Awards, everyone boarded the historic yacht Zumbrota to cruise Marina Del Rey, celebrating the collaboration and shared insights of the day.

Be sure to look out for information on Activate 2020 in the new year!

IDC names mPulse Mobile an Innovator in 2018 Digital Patient Engagement Report

One of the driving forces behind mPulse Mobile is bringing innovation to healthcare to improve outcomes. We are honored to be named an IDC innovator based on our AI-based mobile health engagement solutions and the results we deliver with over 70 healthcare organizations.

IDC Innovators Logo

Cynthia Burghard, research director of IDC Health Insights, highlighted some of the healthcare challenges mPulse Mobile is working to address as well as the value our solutions provide:

“The industry and, more importantly, patients have suffered under inconvenient access to healthcare; digital patient engagement is poised to change that by providing healthcare consumers access to both administrative and clinical support conveniently in a personalized and interactive dialogue when needed. IDC believes this will improve not only the patient experience but improve patient compliance to health management strategies and result in better health”

While mPulse’s solutions make an impact throughout the healthcare industry, IDC highlighted our success in engaging and activating the Medicaid population, which is traditionally very hard to reach. Burghard highlights her assessment of mPulse’s AI-based capabilities.

“Clients can scale their patient engagement strategy to a large number of patients using automated, dynamically personalized communication…With its strength in behavioral science, mPulse has been able to build hundreds of dialogues that are dynamically modified based on the patient’s condition and situation as well as patient data generated and gather during the mobile dialogue.”

To learn more, please see the full IDC Innovators report on mPulse Mobile here.

mHealth Watch Blog Series Week 3: Mobile Appointment Reminders

This week, in the continuation of our new blog series, we’re taking a closer look at the impact of mobile appointment reminders.

No-Show Woes Reduced by mPulse Mobile Appointment Reminders

According to mPulse Mobile’s new Outcomes Report, even well run clinics, with all the technology now available, experience a 12 percent average daily no-show rate.

Determined to make a dent in that disturbing statistic, a world-class Integrated Delivery Network (IDN) approached the matter proactively and with an eye toward technology. The IDN had been delivering appointment reminders via automated telephone calls, but it was neither the most consumer-friendly nor most effective solution.

In an effort to reduce no-shows, the IDN contacted mPulse Mobile, whose expertise aligns with the shifting trend towards text as the consumer preferred channel of communication. Per the findings of a 2016 survey by Sequence, when it comes to communications with healthcare providers, text messages are now preferred over phone calls by a majority of patients.

What mPulse Mobile proposed was its Appointment Reminder solution which delivers personalized, interactive, and automated message workflows for appointment reminders, no-show follow-ups, and satisfaction surveys. Targeted were all patients with scheduled appointments who had provided their mobile numbers at registration (which represented more than 30,000 appointments per month).

The mPulse Mobile Appointment Reminder solution offered patients the option of initiating a rescheduling workflow by replying ‘RS’ to a reminder message. No-shows triggered automated messages to patients and initiated a rescheduling workflow.

Introduction of this text reminder program drastically reduced no-show woes. The no-show rate was cut by 16 percent, generating a positive ROI. Additionally, 2.5 percent of patients used the ‘RS’ reschedule functionality 1 to 3 days before their appointments. This reschedule functionality improved overall slot fills.

Patients were extremely happy with the solution. Not only was the patient satisfaction rate for the program pegged at 97 percent, the program opt-out rate was a mere 2 percent.

mHealth Watch Blog Series Week 2: Clients and Care Plans

This week, in the continuation of mHealth Watch’s blog series  they explore what happens to patients after diagnosis and instructions are provided by doctors and healthcare professionals. Sadly, 50 percent of patients do not adhere to the care plans recommended by their physicians.

Clients and Care Plans: mPulse Mobile Solution Boosts Rx Refill Rates

Consider the case of a large Integrated Delivery Network (IDN), which was concerned about the low medication refill rates among its Medicare patients with chronic conditions. According to mPulse Mobile’s Outcomes Report, call center outreach to this population only achieved an 8 percent refill rate – and the costs were high. Email and paper reminders did not drive any increases in refill rates.

Soon the IDN firm’s Pharmacy Operations Director engaged mPulse Mobile, a company that provides mobile engagement solutions for healthcare, to help devise a better solution to increase the refill rates and reduce the workload demands on the pharmacy call center staff.

A solution was designed to target Medicare patients with diabetes, hypertension, and/or high cholesterol who were partially or completely non-adherent with their medications (based on data about incomplete Rx Refills). Then came implementation of mPulse Mobile’s Rx Refill solution for Care Management.

“The solution delivered an interactive text workflow that notified patients that one or more refills were overdue,” explained an mPulse care management expert. “Patients were then able to complete the refill directly through an interactive text workflow.”

Interestingly, a ‘phone scrub’ determined that a high proportion of devices were feature phones (not smart phones), so the workflow was adjusted to require only simple numeric (1,2,3) patient responses. The solution incorporated a proprietary self-identification functionality to maintain identity-related security.

The results?

While the prior telephone outreach was operationally expensive and spurred a low 8 percent refill rate, the text-driven refill rate was 17.6 percent, with 27 percent of targeted patients engaging in the workflow.

It’s instructive that while younger Medicare beneficiaries were more likely to engage in the program than the rest of the population, the mPulse program proved effective across all age groups. Text communication decreased the back-office processing time for each prescription, helping staffers to double their capacity. Opt out rates from the program? A mere 1.6 percent.

The text-based Rx Refill Solution is one way mPulse Mobile helps healthcare organizations improve care plan adherence for patients with chronic conditions. mPulse Mobile also provides condition specific solutions that improve outcomes and are aligned to quality targets. Diabetes is an area of significant focus, with tailored mobile messaging improving adherence for HbA1c testing, LDL-C screening and retinal eye exams. Completion rates for these check-ups all form part of Diabetes Care HEDIS scores. Learn more about our mobile engagement solutions at

Next Monday, mHealthWatch will present the third blog in this series.

mHealthWatch Publishes Blog Series Highlighting mPulse Mobile’s Patient Engagement Outcomes Report

mPulse Mobile recently released a Patient Engagement Outcomes Report that walks through five innovative mPulse Mobile client programs, including execution details and outcomes. mHealthWatch is publishing a new blog series based on the findings of this report over the next five weeks. We will share each post on the mPulse Mobile blog with additional detail and analysis from our team. First up is a case study showcasing the power of a mobile solution to outperform online ads and mail.

mPulse ‘Patient Access’ Mobile Solution Outperforms Online Ads, Mail

It’s a sad fact of the current state of healthcare that more than 50 percent of individuals with ‘moderate mental illness’ do not receive treatment. Correspondingly, a major dilemma has been how to reach and engage healthcare consumers. But that could soon change, thanks to programs like the one designed by mPulse Mobile. As an illustrative case study, for example, a recent success story points the way to better results.

A behavioral health therapy provider, contracted to provide services to Medicaid beneficiaries with anxiety and depression, needed to increase awareness and enrollment to its service. The company tried online advertising and mail outreach, but it was costly and minimally effective.

The provider then reached out to mPulse Mobile to deliver a more effective and efficient mobile engagement strategy to increase enrollees into the therapy program. The target audience involved custom segments within a wider population of 400,000 Medicaid beneficiaries.

The company implemented mPulse Mobile’s Patient Access solution to efficiently reach and engage large segments of the population in a short period.

“Initially, clinical and demographic datasets were used to assess and segment the 400,000-member population,” according mPulse Mobile’s Outcomes Report. “Next, messaging workflows were implemented with segment-specific language and tone. Individuals had to reply in order to get details of the program and receive a text that contained an embedded link to the therapy site.”

Best of all, the link was trackable to allow insights into the source of site traffic.

What happened? Immediately following the initial text outreach, there was a large spike in web traffic to the therapy site compared to the baseline level driven by online advertising and mailers. Almost immediately, the text channel accounted for 66 percent of weekly therapy sign-ups compared to 11 percent from online advertising and 10 percent from mailed flyers. Opt-out rates from the program were low at 5 percent.

In addition to the clear success of the text channel at increasing awareness and utilization of health services, this use case demonstrated the text channel is much more precision-based than other outreach methods. Organizations can be more strategic about how they conduct their outreach. 95% of messages are read within 3 minutes of being received and response rates frequently reach >30%. This means organizations can launch a targeted campaign to specific patient segments and within hours have powerful metrics to access the impact of the outreach.

Next Monday, mHealthWatch  will present the second blog in this series: the findings of a case study focused on Rx refill rates.